[Cross-posted at Concurring Opinions]

This morning, vindication! When a long New York Times investigative piece says exactly what you have been saying for a long time, it feels very good.

So it is with this morning’s thumbsucker [reg/$$ req’d] about the ridiculous overzealousness and misunderstanding of HIPAA by health care professionals. HIPAA is the Clinton-era law that was principally concerned with making health insurance portable, but has become better known for its privacy-protection requirements. (In fact, the statute largely delegated development of all the details of the privacy provisions to the Department of Health and Human Services, which engaged in a lengthy and torturous rulemaking process.) As recounted at length in the Times piece, many employees at hospitals, doctors’ offices, and insurance companies use the statute’s supposed requirements as a shield for bureaucratic inflexibility in releasing information, even to close family members of an incapacitated patient. I have had numerous encounters with just such ill-informed stubbornness myself, and I find it maddening. (You can only imagine some of the arguments I have had with telephone receptionists who blindly invoke HIPAA.)

In addition to the direct trouble it causes for patients and their family, I fear the continued misuse of HIPAA undermines support for all privacy regulation. This is the only direct contact many people will ever have with privacy law in action. Who could blame them if they conclude that legal privacy restrictions are for the birds? Disregard for patient privacy was widespread before HIPAA, and I have no doubt legal regulation was called for. There have been 27,778 complaints under the law. But those harms are less visible to most of us than the new harm of mindless overprotection.

What’s fascinating is that the excessive caution in response to HIPAA comes against a backdrop of extremely low risk of sanctions. Exclusive enforcement power lies with HHS — the law provides no private right of action. And HHS has never imposed any civil or criminal penalty (although there are three criminal cases ongoing at the moment, those situations are extreme outliers). What explains this risk aversion given the vanishingly small risk of any real penalty?

The article points to one cause: the regulations are long and often vague (though not as bad as some claim); it is always easier to say “no” than to figure out how to say “yes.” HHS must do a better job at presenting plain-English materials. Training of front-line staff — who often have the most public contact — also needs to improve. There are policy changes that could help with these problems, starting with greater effort at HHS.

In addition, I blame the army of consultants who descended on the health care industry after HIPAA passed and exaggerated its complexity to claim that only retention of their high-priced services could ensure compliance. Many offices are still spooked by that sales pitch. Increased clarity from HHS might help here too.

Finally, I agree completely with the HHS official who told the Times,

“Either innocently or purposefully, entities often use this as an excuse. They say ‘Hipaa made me do it’ when, in fact, they chose for other reasons not to make the permitted disclosures.”

I call this last phenomenon “HIPAA-cracy.” You often see the same mindset in dealing with, say, insurance coverage disputes. Inflexibility and unhelpfulness are all too often a part of the modern health care experience. And I’m not sure whether any amount of careful regulatory design can overcome that.

2 Responses to “HIPAA-cracy”

  1. HIPAA is the Clinton-era law that was principally concerned with making health insurance portable, it would be great deal.

  2. “extremely low risk of sanctions.”
    HITECH seems to aim to correct that omission. But if anything HITECH exaggerates the issues raised in this article under prior HIPAA privacy laws. The HIPAA privacy rule shall be beefed up for contractors with access to patient data lower down the health care pipeline. Agree with the author that there was a problem out there regarding patient privacy but do this byzantine set of HHS rules and regulations really get us to a better place?